Manabu Okada1, Yoshihiro Tominaga2, Takayuki Yamamoto2, Takahisa Hiramitsu2, Shunji Narumi2, Yoshihiko Watarai2. 1. Department of Transplantation and Endocrine Surgery, Nagoya 2nd Red Cross Hospital, 2-9 Myoken-cho, Showa-ku, Nagoya, 466-8650, Japan. ubanamadako@yahoo.co.jp. 2. Department of Transplantation and Endocrine Surgery, Nagoya 2nd Red Cross Hospital, 2-9 Myoken-cho, Showa-ku, Nagoya, 466-8650, Japan.
Abstract
BACKGROUND: Reoperative parathyroidectomy (RPTX) because parathyroid glands have been missed is frequently required in patients with secondary hyperparathyroidism (SHPT). The usual locations of these missed glands in patients with SHPT are yet to be fully elucidated. METHODS: We retrospectively investigated the locations of missed glands in 165 patients who underwent RPTX for persistent or recurrent SHPT at our institution from August 1982 to July 2014. At our institution, total parathyroidectomy with forearm autograft is the routine operative procedure for SHPT. We also routinely resect the thymic tongue. RESULTS: Of 165 patients, 82 underwent initial parathyroidectomy at our institution (Group A), and the remaining 83 underwent initial parathyroidectomy at other institutions (Group B). A total of 239 parathyroid glands were resected (Group A, 93; Group B, 146). Missed glands were most commonly located in the mediastinum (Group A, 22/93) and the thymic tongue (Group B, 31/146). CONCLUSIONS: In patients with persistent or recurrent SHPT, ectopic parathyroid glands are frequently located in the mediastinum and thymic tongue. Therefore, resecting the thymic tongue during the initial operation may reduce the need for RPTX.
BACKGROUND: Reoperative parathyroidectomy (RPTX) because parathyroid glands have been missed is frequently required in patients with secondary hyperparathyroidism (SHPT). The usual locations of these missed glands in patients with SHPT are yet to be fully elucidated. METHODS: We retrospectively investigated the locations of missed glands in 165 patients who underwent RPTX for persistent or recurrent SHPT at our institution from August 1982 to July 2014. At our institution, total parathyroidectomy with forearm autograft is the routine operative procedure for SHPT. We also routinely resect the thymic tongue. RESULTS: Of 165 patients, 82 underwent initial parathyroidectomy at our institution (Group A), and the remaining 83 underwent initial parathyroidectomy at other institutions (Group B). A total of 239 parathyroid glands were resected (Group A, 93; Group B, 146). Missed glands were most commonly located in the mediastinum (Group A, 22/93) and the thymic tongue (Group B, 31/146). CONCLUSIONS: In patients with persistent or recurrent SHPT, ectopic parathyroid glands are frequently located in the mediastinum and thymic tongue. Therefore, resecting the thymic tongue during the initial operation may reduce the need for RPTX.
Authors: Angela E Ballinger; Suetonia C Palmer; Ionut Nistor; Jonathan C Craig; Giovanni F M Strippoli Journal: Cochrane Database Syst Rev Date: 2014-12-09
Authors: Jorge Falco; Fernando Dip; Pablo Quadri; Martin de la Fuente; Marcos Prunello; Raúl J Rosenthal Journal: Surg Endosc Date: 2017-03-31 Impact factor: 4.584